06100088 CTS'OF CUPERTINO
BUILDINo DIVISION PERMITE } tMTI� :
BUILDING ADDRESS:
PERMIT NO. OG100088
OWNER'S NAME: PERMIT ISSUE DATE
CATHY SHEFFERO
VE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
pO LICENSED CONTRACTOR'S DECLARATION Job Description
,LU r I hereby affirm that I am licensed under provisions of Chapter 9(commencing
:ZUJ Section 70M)of Divisia of the Business and Professi Code,and my license is
!-<y infullforceandeftict ��1p`3 REROOF- REMOVE EXISTING, REPLACE 30LB FELT,
t ? Licensc Cl s C. Lam•
F° Dale Contractort0YR ELK, CLASS A, 23 SQUARES
ITEL17S DECLARATION
,a
U I understand my plans shall be used as public records
'u.H Licensed Professional
y� OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractors License Law for the
00 following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement
_< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $7000
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(5500).
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Conuactor's License Law docs not apply to an owner of q P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's U-
ccnse Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
LJ I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,Cor c performance of the work for which this permit is issued.
My Work Co ,natio Insuranc()airier and Polity num }rc: ��
Carrier, r Policy No.: , r
C RTIFI E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workcrs'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z CA CONSTRUCTION LENDING AGENCY
F~.r►-� I hereby affirm that there is a construction lending agency for the performance of .
the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
z Lender's Address
U C) I certify that I have read this application and state that the above information is
[>w►-� correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction•and hereby authorize representatives of this city to enter upon the
above-mentioned properly for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date f x'
APPLICANT U DERSTANDS AND WILL COMPLY WITH ALL N N-PO Issued by:
SOURIE R T10 r
V Re-roofs
Signature of Applicant/Contractor bale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the CupertinoFuturcobuilding
icipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes N
Will the applicant or occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
-mit hazardous air contaminan defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes No �o6 1 have aced the hoz rdous materials rc 33and 55 under Chapter the if the Calding //` /yniaHcalth&SafctyCadc, tions 25505.25533 and 25534.1undcrstandthatiCthcbuilding
does not currently have a tenant,that it is my res nsihility to notify the occupant of the
rcquircmentswhich must be e/t(tit ' mane era nifi tcorOccmpanry. Signature ofApplieant Date
Owner or autheri-zcd agent Dare I . All roof coverings to be Class"B"or better
CITY OF CUPERTINO
:m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31630080 . 00
DATE ISSUED. . . . . . . : 10/12/2006
RECEIPT # . . . . . . . . . : 36414
REFERENCE ID # . . . : 06100088
SITE ADDRESS . . . . . : 19911 FIG TREE CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CATHY SHEFFER
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : WALTER FINLEY HIGGIN
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . .
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- --- ------ --- ---------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 7, 000 . 00 137 . 16 0 . 00 137 . 16 0 . 00
BSEISMICRE VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
-- -------- ---------- ---------- ----------
TOTAL PERMIT 242 . 86 0 . 00 242 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- --- ---- ------- -- ------------ ------------- -----
OTHER 242 . 86 VISA
TOTAL RECEIPT 242 . 86
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call fora plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: CCA, I./
job Site Address:
c
Roofing Company Name: 00 K
' + , �
Applicant's Signature: � Date:C —
Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
rUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
6/0000
OWNER'S NAME: (qT PHONE # 2
GENERAL CONTRACTOR: (c, YZ FAX #
I am not using any subcontractors: �(�L.( % G 0 I Z
Signature Dat
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
A 16A6"/—
Owner/Contractor
"/Owner/Contractor Signature Date
CITY OF CUPERTINO
*± REROOF
CW
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
.:�l (V -';3D—M I
Building Address: ,
OtT(s Name: Pho e#:
C ntract License#:
Co l S Z/ 6/z Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
�� Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nu nber of existing coverings ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
JeVscription:
o
�v�
Residential Commercial ❑
Fire Zone: Yes E] No Confirmed with Planning Dept. if
there are any restrictions. LJ
Cost of Project: Type Co ction: Occupancy group.
L 0 0. co 007 UW
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING